Nu-Lane Cargo Services

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NOTE: All Bold items are required to process your application! Non-bolded items are helpful, but not required.
CONTACT INFORMATION
Company Name
Contact Name
Address

City
State
Zip
Phone Number
Cell Phone
Email Address
Web site
FINANCIAL RESPONSIBILTY INFORMATION
Federal Tax ID (or SSN)
Insurance Company Name
Insurance Policy Number
Insurance Company Phone
Insurance Company Contact
EQUIPMENT
Number of Tractors Available
trailer Type Number Available:
trailer Type Number Available:
trailer Type Number Available:
trailer Type Number Available:
Please Explain any Miscellaneous Trailers
NOTE: If you have more than 4 Types of trailers, please fax us a list showing trailer type and quantity.
REFERENCES
Minimum of 2 required – We will not consider any application without two verifiable references.
REFERENCE 1
Name
Address
Telephone Number
REFERENCE 2
Name
Address
Telephone Number
REFERENCE 3
Name
Address
Telephone Number
PREFERRED OPERATING AREAS (STATES)

NOTE: Select multiple states by holding down CTRL key while clicking on desired states. Deselect a state by continuing to hold down the CTRL key while clicking on the state to be removed from your list.

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